Assessment of endocarditis prophylaxis knowledge and attitudes among healthcare practitioners in Tehran and Hamadan.

BACKGROUND: Having knowledge of the dental procedures that necessitate endocarditis prophylaxis is of high importance. Therefore, the aim of the present study was to determine the knowledge level and attitudes of general medical and dental practitioners, dental specialists, and cardiologists in Tehran and Hamadan about endocarditis. METHODS: This cross-sectional study was carried out on 420 general medical and dental practitioners, dental specialists, and cardiologists in Tehran and Hamadan provinces in 2015. The questionnaire used in this research consisted of three parts as follows: part one: information on cardiac diseases; part two: dental procedures requiring endocarditis prophylaxis; part three: antibiotic diet in endocarditis prophylaxis. Independent t-test, one-way ANOVA, and chi-square tests were conducted to analyze the data. All the analyses were performed in SPSS version 16. RESULTS: The results showed that 86.7 had a relatively favorable and 10.5% of subjects had a favorable level of knowledge about endocarditis. Also, 58.6% of subjects had a poor attitude toward endocarditis prophylaxis. There was a significant relationship between knowledge and attitude, age, gender, and work experience (P < 0.001). There was a significant relationship between knowledge and attitude, and job groups; dental specialists had a more favorable knowledge and positive attitude than others (P < 0.001). CONCLUSION: We recommended developing more practical training programs in dental schools on cardiac diseases, and dental procedures requiring endocarditis prophylaxis and antibiotic diets.

Salivary and Serum Antioxidant and Oxidative Stress Markers in Dental Caries.

Dental caries is the most common, chronic, noncommunicable, preventable oral disease worldwide. Oxidation may play an important role in dental caries initiation and progression. Antioxidants in body fluids protect cells. The aim of this study was to evaluate salivary and serum total antioxidant capacity (TAC) and malondialdehyde (MDA) levels in dental caries. A total of 118 healthy caries-free and caries-active male and female students participated. Caries was detected clinically. Unstimulated whole-saliva samples and blood samples were obtained. Sialochemical analysis was carried out by spectrophotometric assay. Data were analyzed with the Student t test using STATA 11. Salivary and serum TAC levels in the case and control groups did not show any significant differences. Mean salivary MDA levels in the case and control groups were 0.71 ± 0.1 and 0.35 ± 0.06 nmol/mL, respectively. The results showed significantly higher levels of salivary and serum MDA in the case group compared to the healthy control group. The oxidative stress marker was significantly higher in the caries group compared to the healthy control group. Antioxidants were not significantly different between the two groups. MDA can be produced by dental caries, resulting in a decrease in antioxidant levels, causing disease progression. Further studies are necessary to determine whether MDA is the cause or effect of the disease.

Evaluation of salivary catalase, vitamin C, and alpha-amylase in smokers and non-smokers: a retrospective cohort study.

BACKGROUND: Saliva and its defence systems such as antioxidants and minerals are very important in the pathogenesis of different diseases. Cigarette smoking has many destructive effects. Oxidative stresses play an important role in the side effects of smoking. This study assessed the effect of cigarette smoking on salivary levels of catalase, vitamin C, and α-amylase. METHODS: This retrospective cohort study was carried out in Hamadan, Iran, on 510 subjects; 259 subjects were smokers (the exposed group) and 251 were non-smokers (the unexposed group). Five microliters of unstimulated saliva was collected by spitting method. Catalase, vitamin C, and α-amylase salivary levels were determined by spectrophotometric assay. Data were analyzed with t-test using STATA 12. RESULTS: Vitamin C level in smokers was significantly lower than that in non-smokers. The salivary catalase levels were lower and α-amylase levels were higher in smokers, but the differences were not statistically significant (P = 0.416 and P = 0.265, respectively). Smokers were younger than non-smokers. CONCLUSION: Smoking resulted in a change in salivary antioxidant levels. Changes in antioxidant levels can influence the deleterious effects of smoking on oral mucosa; it might also indicate systemic changes and changes in the serum levels of oxidative agents. Further studies are necessary to understand the mechanisms and real effects of smoking, to determine the benefits of supplementary antioxidants for treatment and to reduce the dangerous side effects of smoking.

Iranian Women and Health Care Providers' Perception of Oral Health in Pregnancy: A Qualitative Research.

Background: Periodontal diseases during pregnancy are associated with adverse outcomes. This study aimed to explain the perception of healthcare providers and pregnant women about oral health during pregnancy. Materials and Methods: This qualitative study was conducted with the approach of conventional content analysis in health centers of Hamadan, Iran, in 2020. To collect the data, semi-structured in-depth interviews with sixteen pregnant women and eight healthcare providers (gynecologist, midwife, and dentist) were used. Pregnant women with a singleton fetus, lack of chronic diseases and complications of pregnancy, willingness to participate in the study, and the ability to communicate properly were included in the study. Sampling was done purposefully with maximum variety. Data analysis accomplished according to the proposed steps by Graneheim and Lundman using MAXQDA 10 software. Results: "Belief in the importance of oral health in pregnancy," "Lack of a coherent structure for oral care," "Accepting the negative effect of pregnancy on oral health," and "The dilemma of treatment and non-treatment in pregnancy" were four categories extracted from the data. The theme of "Ignoring the mother for the fetus" was obtained as the main theme of the present study. Conclusions: The findings suggest that although mothers and healthcare providers have recognized the importance of oral health in pregnancy, underlying factors in society have led them to understand the mother's oral health should be neglected because of the fetus. This perception can have a negative impact on their behavior, performance, and the oral health of mothers.

Effectiveness of sodium bicarbonate and zinc chloride mouthwashes in the treatment of oral mucositis and quality of life in patients with cancer under chemotherapy.

AIM: The purpose of the study is to evaluate the effectiveness of sodium bicarbonate and zinc chloride mouthwashes on oral mucositis and quality of life in patients undergoing chemotherapy. DESIGN: The present study was a randomized controlled trial study. METHODS: One hundred forty-four patients with a cancer diagnosis were randomly assigned into three groups: sodium bicarbonate mouthwash (n = 48), zinc chloride mouthwash (n = 48) and placebo group (n = 48). The severity of mucositis and quality of life were examined blindly at the baseline and 3-week follow-up. RESULTS: The grade of oral mucositis decreased at the end of the third weeks in the sodium bicarbonate and zinc chloride groups rather than the placebo group (p < .001). The severity of oral mucositis in the sodium bicarbonate and zinc chloride groups decreased from end of the first week until third week (p < .001). In addition, there was significant difference in the severity of oral mucositis among the groups at the end of the second (p = .014) and the third weeks (p < .001). Also, there was a statistically significant difference in quality of life scores between the sodium bicarbonate and zinc chloride mouthwash with the placebo group (p < .001). CONCLUSION: Zinc chloride and sodium bicarbonate mouthwashes were effective in treating and reducing the severity of oral mucositis, and subsequently improving quality of life in patients with cancer under chemotherapy. Therefore, we can recommend zinc chloride and sodium bicarbonate at the beginning of chemotherapy to improve oral health and promoting quality of life in these patients.

Comparison of Salivary Antioxidants and Oxidative Stress Status in Gestational Diabetes Mellitus and Healthy Pregnant Women.

BACKGROUND: One of the most common complications of pregnant women is gestational diabetes mellitus (GDM). Oxidative stress can play an important role in GDM. OBJECTIVE: The aim of this study was to evaluate salivary antioxidants and oxidative stress markers in GDM. METHODS: Twenty pregnant women with GDM and 20 healthy pregnant women with normal blood glucose test participated in this study. Five mL of unstimulated saliva samples were collected. Spectrophotometric assay was carried out for sialo-chemical analysis. Stata software was used for data analysis. RESULTS: The GDM group exhibited no significant difference in salivary total antioxidant capacity and malondialdehyde compared to the healthy control group. All antioxidants markers, the uric acid, total antioxidant, peroxidase and catalase, decreased in GDM group that the difference of peroxidase and catalase was statistically significant. All of oxidative stress markers, the salivary malondialdehyde, total oxidative stress and total thiol, increased in GDM group. GDM group exhibited significantly higher salivary total oxidative stress levels. CONCLUSION: Catalase level was significantly lower and total oxidative stress was significantly higher. These two markers might have significant importance and might exhibit early changes compared to other factors in GDM. Some salivary antioxidants might have diagnostic, prognostic or therapeutic implications in GDM. Other studies with large sample size on salivary and blood samples need to be done to confirm these properties and salivary samples using instead of blood samples in GDM biomarkers changes.

Evaluation of Salivary Lipid Peroxidation End Product Level in Dental Caries.

BACKGROUND: Tissue destruction can be measured by the level of lipid peroxidation (LP) end products. Since free radicals are very reactive with low survival time, the level of free radicals and oxidative stress activity are measured indirectly by tissue damage end product assessment, i.e. Malondialdehyde (MDA) that is a final end product of LP. OBJECTIVE: The aim of this study was to evaluate salivary MDA level as an indicator of oxidative stress; in caries-active and caries-free students. METHODS: A total of 100 male and female students, 15-17 years of age, participated in this casecontrol study. Five mL of whole saliva was obtained. Salivary MDA level was measured spectrophotometrically. Statistical comparisons were performed with Student's t-test, using SPSS 13. RESULTS: Salivary MDA level was significantly higher in the caries-active group compared to the control caries-free group. MDA was also slightly lower in males. CONCLUSION: Higher MDA level might indicate caries-induced oxidative stress. In this study there was a relationship between salivary MDA level and dental caries. Therefore oxidative stress suppression might prevent caries initiation and progression.

Evaluation of Salivary Antioxidants and Oxidative Stress Markers in Type 2 Diabetes Mellitus: A Retrospective Cohort Study.

BACKGROUND: Diabetes Mellitus (DM) is a progressive metabolic disorder. OBJECTIVE: The aim of this study was to investigate the relationship between antioxidant and oxidative stress markers in the saliva of patients with type 2 DM and a healthy control group. METHODS: In this study, 20 patients with diabetes and 20 healthy individuals were evaluated. Salivary antioxidants markers consisted of total antioxidant capacity (TAC), uric acid (UA), peroxidase and catalase. Oxidative stress markers included total oxidant status (TOS), malondealdehyde (MDA) and total thiol (SH). Sialochemical analysis was performed with spectrophotometric assay. All the statistical analyses were conducted using STATA software. RESULTS: TAC decreased significantly in patients with diabetes. Although salivary UA and peroxidase were lower in patients with diabetes compared to the control group, the difference was not significant. Salivary catalase in patients with diabetes was significantly lower than that in the control group. MDA and TOS exhibited significantly higher levels in type 2 DM. SH levels were slightly higher in DM. CONCLUSION: According to the results of the present study, there were some changes in the salivary levels of some antioxidants and oxidative stress markers in patients with type 2 DM and could be measured as an indicator of serum changes.

Evaluation of the Status of Salivary Antioxidants in Dental Caries.

BACKGROUND AND AIM: Dental caries is a communicable and the most prevalent infectious disease worldwide. Salivary oxidative stress and antioxidants may play a pivotal role in caries prevention, progression and pathogenesis. In this study, salivary superoxide dismutase, peroxidase, glutathione peroxidase, catalase and uric acid levels were evaluated in dental caries. MATERIALS AND METHODS: One hundred male and female students in two groups (n=50) were subdivided into caries-active and caries-free (25) groups. Whole saliva samples were collected in the morning, and the salivary antioxidant levels were measured by a spectrophotometric assay. The data were analyzed using SPSS. RESULTS: The caries-active group had higher peroxidase, uric acid, catalase and glutathione peroxidase levels, and lower superoxide dismutase level as compared to the caries-free group. The comparison between males and females showed lower peroxidase, catalase and uric acid levels and higher glutathione peroxidase levels in the female group. CONCLUSION: The caries-active group had altered salivary antioxidant levels. Therefore, it was concluded that salivary antioxidants have significant effects on oral and dental health.

Evaluation of salivary acetylcholinesterase and pseudocholinesterase in patients with Alzheimer's disease: A case-control study.

AIM: The aim of this study was to evaluate acetylcholinesterase (AChE) and pseudocholinesterase (PChE) in whole saliva in patients with Alzheimer's disease (AD) and in healthy subjects. Saliva has a high potential for keeping track of general health and diseases. AD is a type of dementia with reduction in brain cholinergic markers that causes memory, thinking, and behavior problems. Up to 90% decrease in AChE activity has been observed in AD. METHODS AND RESULTS: Thirty healthy subjects and 30 patients with AD participated in this study. Saliva samples were collected from 8 to 10 am. AChE and PChE of saliva were assessed by the Ellman method. Statistical comparison was performed using SPSS 16 for t-test. The activity of AChE and PChE significantly increased in the group with AD compared to the healthy subjects. Sex had no effect on the activities of these enzymes. No correlation existed between the duration of illness and enzymatic activity. The enzyme levels reduced with age. CONCLUSION: AChE and PChE levels were increased in saliva samples of patients with AD. Therefore, saliva has the potential for being used for the purpose of biomarker evaluation to replace cerebrospinal fluid in patients with AD.

Evaluation of Salivary Antioxidants and Oxidative Stress Markers in Male Smokers.

BACKGROUND: Cigarette smoke free radicals can cause cellular damage and different diseases. All the body fluids have antioxidants which protect against free radicals. OBJECTIVE: The aim of this study was to evaluate salivary total antioxidant capacity and peroxidase, uric acid and malondialdehyde levels in smokers and a nonsmoking control group. METHODS: Unstimulated saliva was collected from 510 males. A total of 259 subjects were current smokers and 251 were non-smokers. The levels of salivary total antioxidant capacity, uric acid, peroxidase and malondialdehyde were measured using standard procedures. Data were analyzed with t test and ANOVA. RESULTS: The smokers were younger and dental hygiene index was higher than healthy nonsmoking controls. The mean total antioxidant capacity in smokers and nonsmokers was 0.13±0.07 and 0.21±011, respectively (P=0.001). Smokers had significantly lower peroxidase and uric acid levels than healthy controls. In addition, the mean malondialdehyde levels in the smokers and nonsmokers were 4.55 ±2.61 and 2.79 ±2.21, respectively (P=0.001). CONCLUSION: Cigarette smoke produces free radical and oxidative stress, causing many side effects. Salivary antioxidant levels decreased and malondialdehyde levels increased in smokers, indicating the high oxidative stress among smokers compared to nonsmokers. Cigarette smoke had deleterious effects on main salivary antioxidants levels.

Evaluation of Salivary Alkaline Phosphatase and Albumin in HIV Infected Patients: A Historical Cohort Study.

BACKGROUND: Saliva is a very important complex biological oral fluid .Antioxidants are present in all body fluids. Uric acid, albumin and vitamins are some of the non- enzymatic molecular antioxidants. Alkaline phosphatase is related to cell injury and death. OBJECTIVES: The aim of this study was the evaluation of salivary alkaline phosphatase and albumin level in HIV positive patients in comparison to healthy control group. METHODS: Case groups were 49 HIV positive subjects, compared with 49 healthy control group. Oral clinical examination was carried out. Five ml unstimulated whole saliva was collected during 5 min with the Navazesh method. Alkaline phosphatase was determined by spectrophotometric assay. Albumin was assessed by the nephelometric method. RESULTS: The results of this study showed significantly lower salivary albumin in the case group in comparison to healthy control group (p= 0.001). HIV positive group had greater alkaline phosphatase than the healthy control group. However, this difference was not statistically significant (p=0.458). CONCLUSION: Salivary albumin level was significantly decreased and salivary alkaline phosphatase level slightly increased in HIV positive patients in comparison to healthy control group. All of the HIV infected patients were in early phase of HIV infection with normal immune status. More research is needed to estimate these enzymes changes in late phase of HIV infection and AIDS step.

Evaluation of Salivary Uric Acid and pH in Human Immunodeficiency Virus Infected Patients: A Historical Cohort Study.

OBJECTIVE: Antioxidants protect the body against cellular damage. Saliva has immunological, enzymatic and antioxidant defense systems. Uric acid is the main and predominant salivary antioxidant. The aim of this study was to evaluate salivary uric acid levels and pH in HIV-infected patients in the west of Iran. METHODS: HIV-infected patients were selected from behavioral advisory centers of Hamadan and Kermanshah Provinces, west of Iran. Saliva was collected between 8 and10 in the morning. Five mL of whole unstimulated saliva was collected in 5 minutes by spitting into sterilized Falcon tubes based on Navazesh method; pH was measured with a pH meter and uric acid was assessed with spectrophotometric method. Data were analyzed with STATA 12. RESULTS: Salivary pH in the HIV-positive group was lower (6.99±0.46) than the healthy controls (7.14±1.03) but the difference was not statistically significant (P=380). Uric acid concentrations in HIV-infected patients (2.94±2.14) were significantly lower in comparison to the healthy controls (5.21±2.30). The results showed a statistically significant decrease in the case group (P=0.001). Mean age and DMFT index of the case group were higher than the control group. CONCLUSION: Uric acid, the main antioxidant of saliva, was significantly lower in HIVinfected individuals; pH also was lower in these patients. HIV can alter salivary antioxidant status, which can influence patients' oral health status. Diet with antioxidant properties might be helpful in these patients. More research is necessary to discover true antioxidant and salivary changes and their relation with HIV consequences in future.

Evaluation of Salivary Vitamin C and Catalase in HIV Positive and Healthy HIV Negative Control Group.

BACKGROUND: Saliva is a complex oral biologic fluid secreted by major and minor salivary glands. Saliva has immunological, enzymatic and antioxidant defense mechanisms. Infection with human immunodeficiency virus (HIV) is a life-threatening disease. OBJECTIVE: The aim of this study was to evaluate salivary vitamin C and catalase levels in HIV-positive patients in comparison to a healthy control group. METHOD: Forty-nine HIV-infected individuals and 49 healthy subjects were selected. Five mL of unstimulated saliva was collected in 5 minutes using a sterilized Falcon tube with Navazesh method. Catalase and vitamin C levels were assessed by spectrophotometric assay. Data were analyzed with STATA 12. RESULTS: Salivary catalase levels were 7.99±2.40 and 8.37±1.81 in the case and control groups, respectively. Catalase level was lower in the case group but the difference was not statistically significant (P=0.380). Salivary vitamin C levels in the case and control groups were 3.76±1.92 and 4.87±2.20, respectively (P=0.009). CONCLUSION: HIV can alter salivary antioxidant capacity as well as vitamin C and catalase levels. Saliva may reflect serum antioxidative changes in these patients. Therefore, further research is necessary on salivary and serum oxidants and the antioxidant changes.

Evaluation of Salivary Melatonin Levels in HIV-positive Patients: A Historical Cohort Study.

BACKGROUND: Human immunodeficiency virus (HIV) affects lymphocytes, resulting in acquired immunodeficiency syndrome. Oxidative stress may play an important role in HIV pathogenesis. Melatonin has antioxidant, antiinflammatory and immunomodulatory effects. OBJECTIVE: The aim of this study was to evaluate salivary melatonin levels in HIV-positive patients and a healthy control group. METHODS: Forty-nine HIV-positive and 49 healthy subjects were included in this study. Patients' drug consumption and clinical examination results were registered in questionnaires. Unstimulated whole saliva was collected in the morning. The melatonin levels were measured by melatonin ELISA kits. Statistical analyses were performed with STATA 12, using t-test and chi-squared test. RESULTS: Salivary melatonin levels were significantly lower in the case group in comparison with the healthy control group (P=0.001). Age was significantly higher in the case group. Chi-squared test showed no statistically significant difference between the case and control groups in smoking (P=0.591) and addiction (P=0.204) but gender differences were observed (P=0.001). CONCLUSION: Salivary melatonin level as an antioxidant was lower in HIV-positive patients. Further studies are necessary to understand the exact role of melatonin in HIV-positive patients and its therapeutic effects.

Report of a rare and aggressive case of oral malignant melanoma.

BACKGROUND: Oral melanoma is a very rare malignancy with unknown etiology. Its higher incidence is between 41 and 60 years of age. A high localization of oral melanoma was found in the maxilla. Gender distribution was reported as 1:1. Oral melanoma represents 0.2% to 8% of the all the total cases of melanoma of the body. CASE REPORT: In this article we report an aggressive case of oral melanoma in a 71-year-old male with chief complaint of black swelling of the gingiva, paresthesia, and denture ill fitting. DISCUSSION: Most oral melanomas are asymptomatic and painless in early stages and unfortunately diagnosis delayed until symptoms occurred. Early detection of suspected melanotic lesions by patient, dentist, and physician is very important.

Prevalence of oral mucosal lesions in male smokers and nonsmokers.

Tobacco smoking is one of the most important risk factors for the development of oral mucosal lesions such as leukoplakia and hairy tongue. Controversy exists in the literature, however, about the prevalence of oral lesions in smokers. The aim of this study was to evaluate oral lesions in male smokers compared with nonsmokers in Hamadan. A total of 516 male participants were assessed, 258 of whom were smokers and 258 of whom were healthy nonsmokers. The prevalence of lesions was evaluated by clinical observation and biopsy. We found that the most prevalent lesions among smokers were gingival problems and coated tongue; smokers had significantly more lesions than did nonsmokers. Malignant and premalignant lesions were found in a higher age range. Among all participants in our study, we found a large number of oral mucosal lesions in smokers that had a strong correlation with smoking. Dental services need to implement care and health education for smokers to promote health.

The relationship between the level of salivary alpha amylase activity and pain severity in patients with symptomatic irreversible pulpitis.

OBJECTIVES: Assessment of dental pain severity is very challenging in dentistry. Previous studies have suggested that elevated salivary alpha amylase may contribute to increased physical stresses. There is a close association between salivary alpha amylase and plasma norepinephrine under stressful physical conditions. The aim of this study was to evaluate the relationship between pain severity and salivary alpha amylase levels in patients with symptomatic irreversible pulpitis. MATERIALS AND METHODS: Thirty-six patients (20 females and 16 males) with severe tooth pain due to symptomatic irreversible pulpitis were selected. The visual analogue scale (VAS) score was used to assess the pain severity in each patient. Unstimulated whole saliva was collected, and the level of alpha amylase activity was assessed by the spectrophotometric method. Statistical analysis was performed using SPSS 13. RESULTS: The level of alpha amylase was significantly increased in the saliva in association with pain severity assessed by VAS. The salivary alpha amylase was also elevated with increased age and in males. CONCLUSIONS: There was a significant correlation between the VAS pain scale and salivary alpha amylase level, which indicates this biomarker may be a good index for the objective assessment of pain intensity.

Antibacterial activity of honey on cariogenic bacteria.

OBJECTIVE: Honey has antibacterial activity. The aim of this study was to evaluate the antibacterial activity of honey on Streptococcus mutans and Lactobacillus. MATERIALS AND METHODS: In this in vitro study, solutions containing 0%, 5%, 10%, 20%, 50% and 100%(w/v) of natural Hamadan honey were prepared. Each blood (nutrient) agar plate was then filled with dilutions of the honey. The strains of bacteria were inoculated in blood agar for 24 hours at 37°C and were adjusted according to the McFarland scale (10×10 cfumcl(-1)). All assays were repeated 10 times for each of the honey concentrations. Data were analyzed by non parametric Chi-Square test. Statistical significance was set at α=0.05. RESULTS: Significant antibacterial activity was detected for honey on Streptococcus mutans in concentrations more than 20% and on Lactobacillus in 100% concentration (P<0.05). CONCLUSION: It seems that antibacterial activity of honey could be used for prevention and reduction of dental caries.

Knowledge of General Dentists and Senior Dental Students in Iran about Prevention of Infective Endocarditis.

Infective endocarditis (IE) is an infection of the endothelial surface of the heart and heart valves with serious, even fatal, complications and that often requires long-term and expensive treatment. Dental procedures may lead to IE in high-risk patients. The aim of this study was to evaluate and compare the knowledge of general dentists and dental students concerning the prevention of IE in Hamadan, Iran. In this cross-sectional study, the awareness of general dentists and dentistry students concerning the prevention of IE was evaluated during 2010. A questionnaire was prepared and administered to 58 final-year dental students and 96 general dental practitioners in Hamadan. A total of 154 persons completed the questionnaire. The questionnaire consisted of some demographic questions and questions about awareness of IE in three sections. The gathered data were analyzed by using descriptive statistics, Pearson's chi-square test, Mann-Whitney test, and independent t-tests. The gathered data showed that dentistry students answered the questions about awareness of the prevention of IE more correctly than did general dentists. The overall knowledge of endocarditis prophylaxis among students and dentists was about 65% and 56%, respectively. The students' knowledge was better because 94.9% of the students had desired (acceptable) and relatively desired knowledge; this result for dentists, however, was 82.3%. In our study, the overall awareness level of the study population was moderate. Dentist and students believed that patients with prosthetic valves and previous IE were the most common cardiac disease cases that required prophylaxis. The most common prophylactic regimen was in accordance with the guidelines of the American Heart Association and was a single dose of 2 g amoxicillin 1 hour before treatment. The results indicated that gender had no effect on the level of knowledge; however, there was a statistically significant relationship between age and level of knowledge.